HomeMy WebLinkAboutDrain Layers Permit 55 Lisa Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 0}, 5026
55a 1lq
Pursuant to written application, permission is hereby gran ed to the Licensed Drain Layer
named herein to perform the work indicated below at
r LU G--/4 i�
at premises owned b � , ` � (
Y _:: t- i,..�.P.f� , s _ 4 whose address is
La House Drain and to
3' Repair House Drain, Lay Main, Other
for ,
Family Units, with acres. occupancy or use, with
Type of Sewage to be
WASTES ( ), OR ( ) TRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS '
Desired Starting Date Estimated Time for Completion
Permit to be issued to J(`(( 2"L
the holder of Drain Layer's License No. Z O 29 Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
4L4icensed—Drai ayer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid E ,J j� Permit Fee: Paid
$
Check Number ,, ;
b it r ,\ ;(• Issued by
Tax Office
INSPECTION
Dzte work started
Date complAtaa
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date